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ACUTE EXPOSURE INFORMATION

Because nitric oxide and nitrogen dioxide almost always occur together, this review is based on the properties of nitrogen oxides. Nitrogen dioxide forms nitric acid upon contact with water. It is more acutely toxic than nitric oxide.

Exposure to nitrogen oxides results in acute and chronic changes of the pulmonary system including pulmonary edema, pneumonitis, bronchitis, bronchiolitis, emphysema and possibly methemoglobinemia. Usually, no symptoms occur, except a slight cough, fatigue, and nausea. However, potentially fatal pulmonary edema can occur following minimal early symptoms.

Acute effects may or may not develop within one to two hours after exposure, and include tachypnea, tachycardia, fine crackles and wheezing, and cyanosis. Another acute scenario involves dyspnea and coughing which subside over two to three weeks.

The second stage involves abrupt development of fever and chills, more severe dyspnea, cyanosis, and pulmonary edema. There is no correlation between severity of the first and second stages.

Recovery may be either complete or may involve some degree of impairment of pulmonary function.

Nitrogen dioxide exposure does occur with the use of nitric oxide inhalation therapy in infants. Exposure of nurses and respiratory therapists occurs as well, but is generally transient.